PORTLAND, Ore. – In a first-in-the-nation health care collaboration, Regence members will experience more efficient, effective and affordable care through innovative data-sharing arrangements between the health insurer and two providers, MultiCare and Oregon Health & Science University (OHSU).
These initiatives are part of the HL7® Da Vinci Project, which helps organizations deliver better outcomes on clinical quality, cost and care management. Collaborating with these health systems, Regence is shifting to a value-based care approach powered by seamless data exchange, or “interoperability,” a process that delivers more coordinated care between members and their health care providers.
Accelerating value-based care with focus on medication safety
During one initiative last year, Regence and MultiCare Connected Care—the Accountable Care Organization that is a wholly owned subsidiary of MultiCare Health System—teamed up on a first-in-the-nation Da Vinci Project use case based on HL7® FHIR® (Fast Healthcare Interoperability Resources) as the standard for value-based care data exchange.
Medication reconciliation is the process by which a patient’s medication history is verified to ensure there are no discrepancies when considering medication changes. This reconciliation is often conducted during transfers of care as an important value-based care quality and patient safety measure. This specific partnership enabled MultiCare to send proof that a patient’s medication history had been verified upon hospital discharge. This data is submitted daily and directly to Regence, reducing administrative burden, costs and improving quality.
“Our partnership with Regence has been instrumental to streamlining the clinical workflow and ensuring patient safety,” said Anna Taylor, director of operations, MultiCare Connected Care. “By working together, we were able to quickly reduce labor-intensive administrative work so that our providers can dedicate more time to caring for patients.”
Reducing decision turnaround times
In another initiative, Regence is working with OHSU to expedite and simplify decisions on the most appropriate care for members. The current prior authorization process can be time-consuming for patients, providers and payers, and a costly administrative burden that potentially delays care. Providers need real-time access to health plan coverage requirements to efficiently deliver more informed and timely treatment decisions.
Collaborating with OHSU, Regence is integrating prior authorization tools directly in the electronic health record (EHR), including delivering automatic coverage decisions. Treatment decisions at the point of service help ensure patients receive the right care when they need it most, reducing disruptions to care and improving outcomes.
Enabling success for value-based care programs
In value-based care programs, providers take additional accountability for their patients’ outcomes, experience and affordability. To do this, providers need access to easy-to-understand and actionable patient data. However, the industry currently lacks standards for sharing this data between payers and providers.
Regence is working with MultiCare Connected Care to implement a FHIR-based approach to share key information needed for member attribution in value-based arrangements. As part of this work, Regence’s corporate parent is sponsoring and leading the development of one of the Da Vinci Project’s implementation guides, which will provide a standard, consistent process for providers and payers to share key information needed for members in value-based arrangements.
The goal of all Da Vinci Project use cases is to expand their use to additional providers and payers, establishing new standards for improving data sharing across the industry.
“The more we are able to simplify provider workflows and lighten the administrative load, the more quickly we can accelerate successful value-based care programs for patients, providers and payers alike,” said Kristie Putnam, Regence’s VP of provider partnership innovation. “These innovative partnerships are offering a more complete view of patient history, resulting in a better outcome and more affordable care for patients and increased efficiency overall.”
“Founding members of Da Vinci Project, Regence and its corporate parent provide deep thought leadership, a wealth of subject matter expertise and real-world implementation experience back to the emerging FHIR community across focus areas,” shared Jocelyn Keegan, program manager, Da Vinci Project. “Regence and its partners are demonstrating the power of standards and FHIR to reduce burden and improve outcomes for patients, providers and payers.”
Regence serves approximately 3.1 million members through Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (select counties in Washington). Each health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit Regence.com.
About the HL7 Da Vinci Project
As an HL7 FHIR Accelerator, the Da Vinci Project is a private sector initiative comprised of industry leaders and health information technology technical experts who are working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care (VBC) data exchange across communities. The Da Vinci Project focuses on minimizing the development and deployment of one-off solutions between partners with a goal to help all clinicians and health plans to better deliver clinical quality, value and care management outcomes. The core focus of phase one of the project is to deliver implementation guides and reference software implementations to the public for data exchange and workflows necessary to support providers and payers entering and managing VBC contracts and relationships. To learn more about the Da Vinci Project, visit www.HL7.me/davinci.
About MultiCare Connected Care
MultiCare Connected Care (MCC) is an independent Accountable Care Organization (ACO) established in 2014 as a wholly owned subsidiary of MultiCare Health System and operates as an independent entity. MCC has established a comprehensive Clinically Integrated Network (CIN) comprised of doctors and other health care providers, as well as hospitals, clinics and other health care services, such as imaging, labs and pharmacies. The CIN includes independent health care professionals in the community, as well as MultiCare providers totaling over 3,600 clinicians providing services across the continuum of care.
MCC is a physician-led organization with its own governing board and offers a commercial health benefit plan focus plus Medicare Shared Savings Program (MSSP) and is fast becoming the population health engine representing MultiCare Health System and its independent partners, in transforming health care in our region with 16 Value Based Contracts and serving over 120,000 lives. multicareconnectedcare.com
OHSU is the only academic health center in Oregon and is nationally distinguished as a research university dedicated solely to advancing health sciences. This singular purpose allows us to focus on discoveries that prevent and cure disease, on education that prepares physicians, dentists, nurses and other health professionals for the evolving health care environment, and on patient care that incorporates the latest advances. Based in Portland, we are one of Oregon’s largest employers, operate the top-ranked adult and children’s hospitals in the state, and secure competitive research funding of more than $486 million. As a public organization, we also provide services for the most vulnerable Oregonians and outreach to improve health in communities across the state.